Opinion

Italo Pedicini v. Life Ins. Co. of Alabama

  • 682 F.3d 522
  • 2012 U.S. App. LEXIS 12630
  • 2012 WL 2345215
Court
Court of Appeals for the Sixth Circuit
Filed
Jun 21, 2012
Status
Published
Author
Moore
On the bench
Merritt, Moore, Mays
Cited by
14 cases
Authority
More cited than 72.1%

The opinion

RECOMMENDED FOR FULL-TEXT PUBLICATION

Pursuant to Sixth Circuit Rule 206

File Name: 12a0191p.06

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

_________________

X

Plaintiff-Appellant/Cross-Appellee, -

ITALO PEDICINI,

-

-

-

Nos. 10-6270/6301

v.

,

>

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Defendant-Appellee/Cross-Appellant. -

LIFE INSURANCE COMPANY OF ALABAMA,

-

N

Appeal from the United States District Court

for the Western District of Kentucky at Bowling Green.

No. 1:08-cv-62—Joseph H. McKinley, Jr., Chief District Judge.

Decided and Filed: June 21, 2012

Before: MERRITT and MOORE, Circuit Judges, and MAYS, District Judge.*

_________________

COUNSEL

ON BRIEF: Thomas W. Davis, Glasgow, Kentucky, for Appellant/Cross-Appellee.

Thomas N. Kerrick, KERRICK, STIVERS, COYLE & VAN ZANT, P.L.C., Bowling

Green, Kentucky, Charles A. Dauphin, BAXLEY, DILLARD, DAUPHIN, McKNIGHT

& JAMES, Birmingham, Alabama, for Appellee/Cross-Appellant.

_________________

OPINION

_________________

KAREN NELSON MOORE, Circuit Judge. This appeal and cross-appeal arise

from a dispute regarding the meaning of the term “actual charges” in the context of a

supplemental cancer-insurance policy. The policyholder, Italo Pedicini (“Pedicini”),

contends that “actual charges” refers to the amount billed by a medical provider, while

the insurer, Life Insurance Company of Alabama (“LICOA”), argues that it refers to the

*

The Honorable Samuel H. Mays, Jr., United States District Judge for the Western District of

Tennessee, sitting by designation.

1

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 2

amount actually accepted by a medical provider as full payment. Pedicini sued LICOA

for breach of contract and bad faith after LICOA refused to pay Pedicini benefits due

under his policy pursuant to Pedicini’s interpretation of “actual charges.” The district

court granted summary judgment in Pedicini’s favor on the breach-of-contract claim and

in LICOA’s favor on the bad-faith claims. Both parties appeal their respective adverse

rulings. In addition, Pedicini argues that the district court abused its discretion in

denying Pedicini leave to file a second amended complaint and additional discovery.

Because the district court correctly granted summary judgment for Pedicini as to the

breach-of-contract claim, but incorrectly granted summary judgment for LICOA as to

the bad-faith claims, we AFFIRM the district court’s judgment in part and REVERSE

in part. We also hold that the district court did not abuse its discretion with respect to

Pedicini’s motion to amend, and we remand for consideration by the district court as to

whether further discovery is necessary or justified.

I. BACKGROUND AND PROCEDURAL HISTORY

A. Background

A supplemental cancer-insurance policy is a “valued policy” that ties cash

benefits to charges for qualifying cancer treatments received. R. 43-3 (Christensen Aff.

at 2). The cash benefits are paid directly to the insured, and the insured is at liberty to

use them as he or she wishes. Id. Thus, while a policyholder can use these benefits to

offset the cost of medical treatment, a policyholder with health insurance otherwise

covering those medical costs can utilize the benefits to offset extraneous costs associated

with illness or for any purpose whatsoever. Id.

In 1990, Pedicini purchased a supplemental cancer-insurance policy from

LICOA. R. 17-4 (1990 Policy at 2). The policy provided for unlimited cash benefits

equal to the “usual and customary charges made for” radiation or chemotherapy received

as treatment for cancer. Id. at 4. The policy defined “usual and customary charges” as

“[t]he usual charge made by a person or entity furnishing the services, treatment or

material.” Id. at 10. Because Pedicini’s policy provided unlimited benefits for

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 3

chemotherapy and radiation treatments, his premiums increased dramatically over time.

R. 31 (Pedicini Dep. at 12:6-13). As a result, in 2001, Pedicini contemplated terminating

his policy and solicited the advice and assistance of the insurance agent from whom he

purchased car and homeowners insurance, Jerry Hardison (“Hardison”). Id. at 12:18-20,

13:7-9. Hardison contacted LICOA and negotiated a virtually identical policy that

capped Pedicini’s benefits for chemotherapy and radiation treatments at twenty-five

thousand dollars per year, thereby significantly lowering the requisite premium

payments. Id. at 12:22-13:6. The new policy tied the radiation and chemotherapy

benefits to “actual charges” for those treatments and defined “actual charges” as “actual

charges made by a person or entity furnishing the services treatment or material.” R. 17-

4 (2001 Policy at 10, 16). The new policy became effective on October 1, 2001. Id. at

3.

Unbeknownst to Pedicini, approximately eight months earlier in February

2001, LICOA changed its benefit-payment practices. R. 32 (Casey Dep. at 25:11-14).

For approximately twenty years prior to February 2001, LICOA paid benefits tied to

“actual charges” according to the amount billed by medical providers regardless of the

amount medical providers accepted as full payment. See id. at 26:1-5. However, in

February 2001, LICOA abandoned this policy and began paying benefits equal to the

amount accepted as full payment by medical providers. Id. at 123:13-17; 153:11-17. In

many instances, this resulted in lower benefit payments because of discounted rates

required by Medicare and/or previously negotiated by private health-insurance providers.

See id. at 87:1-89:12. LICOA contends that it enacted this change upon learning that

new medical-billing practices were resulting in overcharges and a surplus in benefit

distributions. Id. at 25:11-19. LICOA did not provide notice to policyholders of the

change, although it did provide notice to its servicing agents. Id. at 31:22-33:10. Many

policyholders became aware of the change only upon receiving a reduced benefit

payment. See id.

In February 2007, Pedicini was diagnosed with cancer. R. 68-3 (Pedicini Aff.

at 2). After Pedicini began receiving treatments qualifying for the chemotherapy and

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 4

radiation benefit under his policy, he submitted claims to LICOA. See R. 31 (Pedicini

Dep. at 21:5-12). Upon receiving his first benefit payment, Pedicini realized that

LICOA was not providing him benefits equal to the amount billed by his medical

provider, but rather only equal to the discounted amount accepted by his medical

provider in light of his status as a Medicare recipient. Id. at 21:15-22:20.1 When

Pedicini called LICOA to inquire about the discrepancy, LICOA informed him that

LICOA would only pay benefits equal to the amount accepted by the medical provider

as full payment in light of Medicare discounts. Id. at 21:21-22:20. LICOA also

instructed Pedicini to include documentation of the amount actually accepted by his

medical provider as full payment, i.e., evidence of payments made by Medicare and any

other health insurance provider, when submitting future claims. Id. at 22:8-20. To date,

LICOA has paid Pedicini benefits under the policy only according to LICOA’s

interpretation of “actual charges.”

B. Procedural History

Pedicini filed a complaint against LICOA in Kentucky state court and asserted

claims for breach of contract, breach of good faith and fair dealing, bad faith, violations

of the Kentucky Unfair Claims Settlement Practices Act, and punitive damages. R. 1-3

(First Amended Compl.). LICOA removed the action to federal district court on the

basis of diversity jurisdiction. R. 1 (Notice of Removal). The district court bifurcated

the breach-of-contract claim from the bad-faith claims, R. 25 (Dist. Ct. Order), and both

parties moved for summary judgment as to the breach-of-contract claim, R. 42 (Plaintiff

Summary Judgment Mot.); R. 44 (Defendant Summary Judgment Mot.). The district

court granted summary judgment in Pedicini’s favor, finding that because the term

“actual charges” was ambiguous, it must be construed in Pedicini’s favor under

Kentucky law. R. 60 (Dist. Ct. Op. at 11).

1

Pedicini also holds a Medicare supplemental policy with Anthem Blue Cross and Blue Shield,

which offsets the cost of treatments not covered by Medicare. R. 31 (Pedicini Dep. at 22:21-23:10). As

a result, Pedicini has paid no out-of-pocket expenses for his cancer treatments. Id. at 23:11-13.

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 5

Thereafter, LICOA moved for summary judgment on the remaining bad-faith

claims. R. 66 (Defendant Summary Judgment Mot.). In addition to responding to

LICOA’s summary judgment motion, Pedicini entered a number of deposition notices,

see R. 68 (Response to Summary Judgment Mot.); R. 69-75 (Dep. Notices), and moved

to file a second amended complaint, R. 78 (Amended Compl. Mot.). The district court

granted LICOA’s motion for summary judgment finding “that because the interpretation

of the term ‘actual charges’ under the supplemental cancer insurance policy is fairly

debatable, Plaintiff’s common law and statutory bad faith claims may not be

maintained.” R. 82 (Dist. Ct. Op. at 4). The district court also denied Pedicini’s motion

to file an amended complaint as untimely and declined to grant further discovery. Id. at

6. The district court entered judgment as to all claims on September 20, 2010. R. 83

(Judgment). Pedicini and LICOA timely appealed and cross-appealed, respectively.

R. 84 (Notice of Appeal); R. 85 (Notice of Cross-Appeal).

II. ANALYSIS

A. Breach-of-Contract Claim

LICOA challenges the district court’s conclusion that Pedicini is entitled to

summary judgment on the breach-of-contract claim because the term “actual charges”

is ambiguous as a matter of Kentucky law. We review a grant of summary judgment on

a breach-of-contract claim de novo. See Jones v. Union Cnty., 296 F.3d 417, 423 (6th

Cir. 2002).

“As a federal court sitting in diversity, we apply the choice-of-law provisions of

the forum state.” NILAC Int’l Mktg. Grp. v. Ameritech Servs., Inc., 362 F.3d 354, 358

(6th Cir. 2004) (citing Klaxon Co. v. Stentor Elec. Mfg. Co., 313 U.S. 487, 496 (1941)).

Under Kentucky law, the law of the state with “the most significant relationship to the

transaction and the parties” governs the dispute. State Farm Mut. Auto. Ins. Co. v.

Marley, 151 S.W.3d 33, 42 (Ky. 2004) (quoting RESTATEMENT (SECOND) OF CONFLICT

OF LAWS § 188 (1971)) (internal quotation marks omitted). The parties do not dispute

that Kentucky law applies.

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 6

Under Kentucky law, “the construction and legal effect of an insurance contract

is a matter of law for the court.” Bituminous Cas. Corp. v. Kenway Contracting, Inc.,

240 S.W.3d 633, 638 (Ky. 2008). Kentucky law requires that an ambiguous term in an

insurance policy “be liberally construed so as to resolve all doubts in favor of the

insured.” Id. “A contract is ambiguous if a reasonable person would find it susceptible

to different or inconsistent interpretations.” Cantrell Supply, Inc. v. Liberty Mut. Ins.

Co., 94 S.W.3d 381, 385 (Ky. Ct. App. 2002). No Kentucky court has decided whether

the contractual term “actual charges” is ambiguous under Kentucky law, and the Sixth

Circuit has only alluded tangentially to a similar issue. See Gooch v. Life Investors Ins.

Co. of Am. (In re Life Investors Ins. Co. of Am.), 589 F.3d 319, 326 (6th Cir. 2009)

(expressly acknowledging that court need not consider merits in the context of the claim

presented).

The district court concluded that the policy term “actual charges” is ambiguous

and, therefore, must be construed in Pedicini’s favor. LICOA argues that “actual

charges” is not ambiguous and plainly refers to the amount accepted by a medical

provider as full payment for the service or treatment. In support, LICOA cites an

opinion from the Middle District of Alabama, which concluded that “actual charges” was

unambiguous and emphasized dictionary definitions of “‘actual’ [as] ‘real,’ ‘existing,’

not ‘potential’ or ‘possible.’” Claybrook v. Cent. United Life Ins. Co., 387 F. Supp. 2d

1199, 1204 (M.D. Ala. 2005) (quoting THE AMERICAN HERITAGE DICTIONARY (4th ed.

2000)).2 The weight of authority is against LICOA’s position.

2

LICOA also cites Jarreau v. Cent. United Life Ins. Co., No. Civ. A. 05-83-FJP-SCR, 2006 WL

2086011 (M.D. La. May 16, 2006) (unpublished opinion), and Ward v. Dixie Nat’l Life Ins. Co., No. 3:03-

3239-JFA, 2006 WL 1529398 (D.S.C. May 10, 2006), vacated, 257 F. App’x 620 (4th Cir. 2007)

(unpublished opinion). However, Jarreau merely summarily adopts the decisions in Ward and Claybrook.

Moreover, the District Court of South Carolina’s decision in Ward was eventually overturned. The District

Court of South Carolina had granted summary judgment in favor of the insurer on the breach-of-contract

claims after certifying a statewide class of policyholders. Ward, 257 F. App’x at 622. The Fourth Circuit

initially affirmed class certification, but concluded that summary judgment on the contract claims was

improper and, thus, remanded for further proceedings. Id. Both parties petitioned the Fourth Circuit for

rehearing and the insurer petitioned for rehearing en banc. Id. “Because no member of the court called

for a vote on [the insurer’s] petition for rehearing en banc, the petition was denied.” Id. at 622 n.2 (citing

Fourth Circuit Local Rule 35(b)). However, the Fourth Circuit panel did grant Ward’s petition for

rehearing and, concluding that the policy term “actual charges” was “patently ambiguous,” ordered that

summary judgment be entered in Ward’s favor on the breach-of-contract claim. Id. at 627. In the

aftermath of the decision, South Carolina enacted legislation defining “actual charges” as the amount

accepted by a medical provider as full payment, but the Fourth Circuit declined to apply the statute

retroactively and affirmed the district court’s judgment awarding substantial damages to the plaintiff class.

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 7

The Fourth and Fifth Circuits, the only circuits to address the issue squarely,

have held that the term “actual charges” is ambiguous. Ward v. Dixie Nat. Life Ins. Co.,

257 F. App’x 620, 627 (4th Cir. 2007) (unpublished opinion), cert. denied, 555 U.S. 938

(2008); Guidry v. Am. Pub. Life Ins. Co., 512 F.3d 177, 184 (5th Cir. 2007). In Ward,

while the Fourth Circuit concluded that “actual charges” is a term of art, it nevertheless

found the term “patently” ambiguous after surveying definitions in the medical context.

257 F. App’x at 625-26; see also Ward v. Dixie Nat. Life Ins. Co., 595 F.3d 164, 170

(4th Cir. 2010) (affirming class action damages award based on “actual charges”

including full amount billed by medical providers). In Guidry, the Fifth Circuit

concluded that the Black’s Law Dictionary definition of “‘actual’ as ‘[r]real, substantial;

existing presently in fact’” just as reasonably suggested that “actual charges” means the

amount billed rather than the amount accepted as full payment. 512 F.3d at 182-83

(alteration in original) (quoting BLACK’S LAW DICTIONARY (6th ed. 1990)). The Fifth

Circuit also took issue with the insurer’s position that the term should be unambiguously

construed in its favor given that the insurer had previously paid benefits equal to the

amount billed by the medical provider. Id. at 184. The court classified the insurer’s

position as “suspect” and noted that it “seems very strange that a for-profit company

would continue to pay benefits for years based on the larger billed amount when it was

allegedly so clear that ‘actual charges’ meant the amount of the discounted bill.” Id.

The Eleventh Circuit addressed a related issue and held that the term “actual

charges incurred” unambiguously referred to the “amount the provider accepts from an

insurer as full satisfaction of the policyholder’s liability.” Phila. Am. Life Ins. Co. v.

Buckles, 350 F. App’x 376, 379 (11th Cir. 2009) (unpublished opinion) (emphasis

added) (internal quotation marks omitted). In so concluding, the Eleventh Circuit relied

on the meaning of the qualifying word “incurred,” expressly declining “to consider the

meaning of ‘actual charges’ standing alone.” Id. Though not conclusive, the Eleventh

Circuit’s decision lends support to the conclusion that “actual charges” is ambiguous.

Were the term “actual charges” as clear as LICOA suggests, it seems unlikely that two

Ward v. Dixie Nat’l Life Ins. Co., 595 F.3d 164, 170 (4th Cir. 2010).

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 8

of our sister circuits would hold otherwise with a third taking pains to avoid deciding the

question entirely.

We hold that the term “actual charges” is ambiguous. As evidenced by the

decisions of our sister circuits, the thoughtful arguments presented by both parties, and

LICOA’s shift in its benefit-payment practices, it is clear that “a reasonable person

would find [the term “actual charges”] susceptible to different or inconsistent

interpretations” thus making it ambiguous under Kentucky law. See Cantrell Supply, 94

S.W.3d at 385. We agree with the Fifth Circuit that dictionary definitions are unhelpful,

as “real” and “existing” charges could just as reasonably refer to the billed amount as

well as to the amount accepted as full payment. Moreover, the fact that LICOA paid

benefits equal to the amount billed for approximately twenty years prior to February

2001 seriously undermines its position that the term “actual charges” unambiguously

means the amount accepted as full payment. While perhaps LICOA is uncannily

altruistic, it is more likely that the change in its benefit-payment practices reflects

LICOA’s own struggles with the ambiguous terms of its policies. Because the term is

ambiguous, it must be construed in favor of Pedicini as a matter of Kentucky law. See

Bituminous, 240 S.W.3d at 638. Accordingly, we affirm summary judgment in favor of

Pedicini on the breach-of-contract claim.

B. Bad-Faith Claims

Pedicini challenges the district court’s determination that he cannot sustain his

bad-faith claims under Kentucky law. We review the district court’s summary judgment

determination de novo. See Jones, 296 F.3d at 423.

Under Kentucky law, a plaintiff must establish three elements to succeed on a

bad-faith claim: “(1) the insurer must be obligated to pay the claim under the terms of

the policy; (2) the insurer must lack a reasonable basis in law or fact for denying the

claim; and (3) it must be shown that the insurer either knew there was no reasonable

basis for denying the claim or acted with reckless disregard for whether such a basis

existed.” Wittmer v. Jones, 864 S.W.2d 885, 890 (Ky. 1993) (internal quotation marks

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 9

omitted).3 Based on the resolution of the breach-of-contract claim, it is clear that

LICOA had an obligation to pay Pedicini the full amount billed for the covered medical

services. Thus, the first element of the test is satisfied. However, the underlying merits

of an individual’s insurance claim are not dispositive with respect to a claim of bad faith.

See Cowan v. Paul Revere Life Ins Co., 30 F. App’x 384, 388 (6th Cir. 2002)

(unpublished opinion). Pedicini must also demonstrate the second and third elements

of the test.

The district court relied on Empire Fire & Marine Insurance Co. v. Simpsonville

Wrecker Service, Inc., 880 S.W.2d 886, 891 (Ky. 1994), to find that Pedicini failed to

establish the second element of the bad-faith test. In Empire Fire, the Kentucky

Supreme Court held “that where there is a legitimate first-impression coverage question

for purposes of Kentucky law and recognized authorities support the insurer’s position

in denying coverage, the insured’s claim is fairly debatable as a matter of law and will

not support a claim of bad faith.” Id. Pedicini argues that it is not Empire Fire, but

Farmland Mutual Insurance Co. v. Johnson, 36 S.W.3d 368 (Ky. 2001), that controls

the outcome in this case. In Johnson, the Kentucky Supreme Court held that an insurer

that had allegedly conspired with appraisers to avoid paying the full amount of

compensation due to an insured was not entitled to summary judgment on a bad-faith

claim. Id. at 371-72. We agree with Pedicini that summary judgment for LICOA on the

bad-faith claims is improper in this instance.

An objective assessment of the legal landscape evidences that LICOA lacked a

reasonable basis in law for disputing Pedicini’s claim to benefits according to his

interpretation of “actual charges.” Under clearly established Kentucky law, ambiguous

contractual terms are construed in favor of the insured. The term “actual charges” is

“patently ambiguous,” Ward, 257 F. App’x at 625-27; the use of the term in the

supplemental policy is hopelessly circular, as the term “actual charges” even appears

within its own definition in the policy. Moreover, for twenty years prior to February

3

These requirements apply whether the bad-faith claim is based in common law or statute.

Shepherd v. Unumprovident Corp., 381 F. Supp. 2d 608, 612 (E.D. Ky. 2005) (citing Curry v. Fireman’s

Fund Ins. Co., 784 S.W.2d 176, 178 (Ky. 1989)).

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 10

2001, LICOA had paid benefits equal to the amount billed by medical providers,

inspiring expectations among its policyholders regarding the value of their benefits. In

light of these facts, LICOA should have realized that unilaterally altering its definition

of “actual charges” was likely to result in legal claims against it by its policyholders and

that, under Kentucky law, LICOA would lack a reasonable basis for denying those

policyholders relief. LICOA points to no legal authority contemporaneous with its

February 2001 policy change suggesting otherwise. The opinions that LICOA cites as

“recognized authorities” in support of its position all post-date February 2001 and thus

could not have informed LICOA’s determination of the reasonableness of its action at

that time. See Empire Fire, 880 S.W.2d at 889 (citing authority relied upon by the

insurer as being in existence “as of the date of appellee’s loss”); Phelps, 245 F. App’x

at 487 (same); Cowan, 30 F. App’x at 387 (same). As a result, it is difficult to see how

LICOA can maintain that the proper resolution of its dispute with Pedicini is “fairly

debatable as a matter of law.” Empire Fire, 880 S.W.2d at 889.

Moreover, based on the facts pleaded by Pedicini, a reasonable jury could

conclude that the third element of the bad-faith test is satisfied: that LICOA acted

knowingly or in reckless disregard of the lack of legal basis for its interpretation.

LICOA did not alter its benefit-payment practices in an open and transparent manner.

Those currently receiving benefits learned of the change only upon receiving a decreased

benefit payment after the change came into effect, and other policyholders not yet

qualifying for the receipt of benefits, like Pedicini, did not learn of the change until years

later when they became ill and eligible to receive benefits. As a result of the change,

LICOA was able to transform its profitability from a loss of over two million dollars in

calendar year 2000 to a profit of approximately one million and seven hundred thousand

dollars in calendar year 2001. From these facts a reasonable jury could conclude that

LICOA acted in bad faith by concealing changes in its benefit-payment practices to

avoid the loss of premium payments essential to its profitability in calender year 2001.

The Kentucky Supreme Court has found summary judgment on a bad-faith claim

improper amidst similar allegations of deceit in furtherance of pecuniary gain. See

Johnson, 36 S.W.3d at 372, 375 (denying summary judgment on bad-faith claim where

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 11

insurer allegedly conspired with appraisers to undervalue policyholder’s claim); see also

Zilisch v. State Farm Mut. Auto. Ins. Co., 995 P.2d 276 (Ariz. 2000) (en banc) (denying

summary judgment in favor of insurer where insurer allegedly refused to negotiate a

reasonable settlement with insured, who ended up receiving an arbitration award more

than six times greater than that offered by the insurer).4

Based on the foregoing, we conclude that sufficient factual disputes surround the

bad-faith claims such that summary judgment for LICOA is improper. Accordingly, we

reverse the district court’s grant of summary judgment in favor of LICOA on these bad-

faith claims and remand for further proceedings.

C. Amended Complaint and Discovery Motions

Pedicini also challenges the denial of his motion for leave to file a second

amended complaint and the denial of his motion for additional discovery. We review

the district court’s decision in both regards for an abuse of discretion. Hamilton Cnty.

Bd. of Comm’rs v. Nat’l Football League, 491 F.3d 310, 320 (6th Cir. 2007); Yuhasz v.

Brush Wellman, Inc., 341 F.3d 559, 569 (6th Cir. 2003).

Pedicini argues that the district court abused its discretion in refusing leave to

amend the complaint in light of LICOA’s failure to disclose that the Kentucky

Department of Insurance found that LICOA’s change in the interpretation of “actual

charges” discriminated against policyholders and violated KRS 304.12-080. See R. 68-6

(Rate Filing Approval Order at 2). Pedicini requests that the complaint be amended to

reflect an additional cause of action for discrimination under Kentucky law as well as

additional evidence obtained during discovery in support of the bad-faith claims. The

district court did not abuse its discretion in determining that Pedicini’s request to add the

discrimination claim was untimely and should have been made prior to the resolution of

the breach-of-contract claim. Counsel’s questioning during the Casey deposition gave

clear indication that counsel was aware of possible claims of discrimination in relation

4

Although in a distinct factual context, this Court also recently reversed a grant of summary

judgment in favor of a defendant on a bad-faith claim under Kentucky law. See Phelps v. State Farm Mut.

Ins. Co., --- F.3d ---, 2012 WL 1889396, *6 (6th Cir. May 25, 2012).

Nos. 10-6270/6301 Pedicini v. Life Ins. Co. of Ala. Page 12

to LICOA’s new charging policy, and counsel did not need the Kentucky Department

of Insurance’s finding to plead this claim. See R. 32 (Casey Dep. at 140:4-141:1).

However, in light of our reversal of the district court’s grant of summary judgment in

favor of LICOA on the bad-faith claims, we remand for further consideration by the

district court as to whether leave to amend the complaint in support of the bad-faith

claims is proper.

Because we reverse the district court’s grant of summary judgment in favor of

LICOA on the bad-faith claims, Pedicini’s objections to a decision on summary

judgment prior to additional discovery are moot. In light of the remand, however, the

district judge may consider whether any further discovery is necessary or appropriate.

Accordingly, we affirm the district court’s rulings on both motions.

III. CONCLUSION

Based on the foregoing, we AFFIRM the judgment of the district court granting

summary judgment to Pedicini on the breach-of-contract claim and denying Pedicini’s

motion to file a second amended complaint and Pedicini’s motion for additional

discovery. We VACATE the district court’s grant of summary judgment in favor of

LICOA on the bad-faith claims and REMAND for proceedings consistent with this

opinion.

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.

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